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Malnutrition Workup

  • Author: Harohalli R Shashidhar, MD; Chief Editor: Jatinder Bhatia, MBBS, FAAP  more...
Updated: Mar 10, 2016

Laboratory Studies

See the list below:

  • The most helpful laboratory studies in assessing malnutrition in a child are hematological studies and laboratory studies evaluating protein status.
    • Hematological studies should include a CBC count with RBC indices and a peripheral smear. This could also help exclude anemias from nutritional deficiencies such as iron, folate, and vitamin B-12 deficiencies.
    • Measures of protein nutritional status include serum albumin, retinol-binding protein, prealbumin, transferrin, creatinine, and BUN levels. Retinol-binding protein, prealbumin, and transferrin determinations are much better short-term indicators of protein status than albumin. However, in the field, a better measure of long-term malnutrition is serum albumin because of its longer half-life.
  • Additional diagnostic evaluation
    • In children who have a history of adequate food intake and signs/symptoms of malnutrition, focus on identifying the cause of malnutrition. Perform laboratory studies based on information from a complete history and physical examination.
    • Initial diagnostic laboratory studies include a CBC count, sedimentation rate, serum electrolytes, and urinalysis and culture. Stool specimens should be obtained if the child has a history of abnormal stools or stooling patterns or if the family uses an unreliable or questionable source of water.
    • Additional studies may focus on thyroid functions or sweat chloride tests, particularly if height velocity is abnormal. Further diagnostic studies should be determined as dictated by the history and physical examination. For example, lab tests evaluating renal function, such as phosphorus and calcium, should be obtained in the presence of renal symptoms. Children with suspected liver disease should have triglyceride and vitamin levels obtained, while zinc levels should be obtained in patients with chronic diarrhea.
  • Celiac serology is a useful screening test and should be considered, especially if there is a family history of celiac disease or if other autoimmune diseases, such as type I diabetes mellitus, are present.

Other Tests

See the list below:

  • Practical nutritional assessment
    • Complete history, including a detailed dietary history
    • Growth measurements, including weight and length/height; head circumference in children younger than 3 years
    • Complete physical examination
  • Sensitive measures of nutritional status
    • Height-for-age or weight-for-height measurements greater than 2 standard deviations below the mean for age
    • Height-for-age or weight-for-height measurements more than 2 standard deviations less than the mean for age
    • Height-for-age measurements less than 95% of expected value
    • Height-for-height measurements less than 90% of expected value
    • Less than 5 cm/y of growth in children older than 2 years
    • Body mass index (BMI), although this is not established by the Centers for Disease Control and Prevention (CDC) as a criteria for failure to thrive
Contributor Information and Disclosures

Harohalli R Shashidhar, MD Associate Professor, Department of Pediatrics, Chief, Division of Pediatric Gastroenterology and Nutrition, University of Kentucky Medical Center

Harohalli R Shashidhar, MD is a member of the following medical societies: American Academy of Pediatrics, Kentucky Medical Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.


Donna G Grigsby, MD Associate Professor, Department of Pediatrics, University of Kentucky College of Medicine

Donna G Grigsby, MD is a member of the following medical societies: Kentucky Chapter of The American Academy of Pediatrics, Kentucky Pediatric Society, American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Jatinder Bhatia, MBBS, FAAP Professor of Pediatrics, Medical College of Georgia, Georgia Regents University; Chief, Division of Neonatology, Director, Fellowship Program in Neonatal-Perinatal Medicine, Director, Transport/ECMO/Nutrition, Vice Chair, Clinical Research, Department of Pediatrics, Children's Hospital of Georgia

Jatinder Bhatia, MBBS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Pediatric Society, American Society for Nutrition, American Society for Parenteral and Enteral Nutrition, Academy of Nutrition and Dietetics, Society for Pediatric Research, Southern Society for Pediatric Research

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Gerber.

Additional Contributors

Maria Rebello Mascarenhas, MBBS Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Section Chief of Nutrition, Division of Gastroenterology and Nutrition, Director, Nutrition Support Service, Children's Hospital of Philadelphia

Maria Rebello Mascarenhas, MBBS is a member of the following medical societies: American Gastroenterological Association, American Society for Parenteral and Enteral Nutrition, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

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Hormonal adaptation to the stress of malnutrition: The evolution of marasmus.
A classic example of a weight chart for a severely malnourished child.
This infant presented with symptoms indicative of a dietary protein deficiency, including edema and ridging of the toenails. Image courtesy of the Centers for Disease Control and Prevention.
This infant presented with symptoms indicative of Kwashiorkor, a dietary protein deficiency. Note the angular stomatitis indicative of an accompanying Vitamin B deficiency as well. Image courtesy of the Centers for Disease Control and Prevention.
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